CN104434243A - End effector, surgical operating instrument and purse-string forceps - Google Patents

End effector, surgical operating instrument and purse-string forceps Download PDF

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Publication number
CN104434243A
CN104434243A CN201310438123.9A CN201310438123A CN104434243A CN 104434243 A CN104434243 A CN 104434243A CN 201310438123 A CN201310438123 A CN 201310438123A CN 104434243 A CN104434243 A CN 104434243A
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CN
China
Prior art keywords
tong arm
purse
syringe needle
needle
end effector
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Granted
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CN201310438123.9A
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Chinese (zh)
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CN104434243B (en
Inventor
刘刚
孙斌
方云才
汪炬
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Tianjin Ricky surgical instruments Limited by Share Ltd
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REACH SURGICAL INSTRUMENT (CHINA) CO Ltd
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Priority to CN201310438123.9A priority Critical patent/CN104434243B/en
Publication of CN104434243A publication Critical patent/CN104434243A/en
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B17/07207Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/11Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • A61B17/115Staplers for performing anastomosis in a single operation
    • A61B17/1155Circular staplers comprising a plurality of staples

Abstract

The invention relates to the technical field of medical equipment, and discloses an end effector and a surgical operating instrument comprising the end effector in order to simplify the operation process of a lumen tissue operation and shorten the operation time. The end effector comprises a first forceps arm, a second forceps arm, a suture mechanism, a purse-string suture mechanism and a cutting mechanism, wherein the first forceps arm and the second forceps arm can move relatively under the effect of an opening and closing mechanism so as to enable a forceps opening formed by the first forceps arm and the second forceps arm to be opened or closed, the suture mechanism is arranged on one side of the longitudinal direction of the two forceps arms, the purse-string suture mechanism is arranged on the other side of the longitudinal direction of the two forceps arms, and the cutting mechanism is arranged between the suture mechanism and the purse-string suture mechanism. The invention further provides purse-string forceps. The purse-string forceps can prevent needles from falling and improve the safety of the operation.

Description

End effector, surgical operating instrument and purse-string forceps
Technical field
The present invention relates to technical field of medical instruments, particularly relate to a kind of end effector, a kind of surgical operating instrument and a kind of purse-string forceps.
Background technology
Gastrointestinal surgery needs to cut off closing tissue tube chamber usually, and carries out purse string suture at the tube chamber place, side disconnected, and the nail anvil of round anastomat is installed at purse string suture place for coordinating, to use round anastomat to carry out follow-up operation such as identical grade.
Purse string suture is the mode of a kind of common suturing skill in surgical operation, the purse string suture that known existence two kinds is main.A kind of mode carries out purse string suture by hand, as shown in Figure 1 a, 1 b, doctor first around the otch of lumen organization 25 with pocket pin with purse wire 17 through tissue surface, then tighten up purse wire 17 and can complete purse string suture.The mode complicated operation of manual suture, the more difficult assurance of performance accuracy, and easily because off-line causes sewing up unsuccessfully, be seldom used in the section's of being out at present operation.
Another kind of mode uses purse-string forceps to assist to carry out purse string suture.As shown in Figure 2 a, a kind of purse-string forceps is utilize the mode of (i.e. pocket pin 16) band wire (i.e. purse wire 17) of threading a needle to carry out purse string suture equally.As shown in Figure 2 b, a kind of purse-string forceps is also had to be by pocket nail 57, purse wire 17 be attached to lumen organization 25 surface and carry out purse string suture, common mode is percussion pocket nail 57 and makes it thrust and be fixed to lumen organization 25, and purse wire 17 or and pocket follow closely 57 between be interconnected, or be pressed between lumen organization 25 and pocket nail 57 by pocket nail 57, thus purse wire 17 is attached to lumen organization 25, to realize purse string suture.
Usually when performing the operation to lumen organization, except needing to carry out except purse string suture to the remaining end otch of lumen organization, also need to cut its pathological changes end, sew up.And existing purse-string forceps function singleness, the purse string suture to remaining end can only be completed, the cutting and stitching to pathological changes end cannot be realized.Therefore at least also need with the use of operating theater instruments such as other staplers, the operation changing operating theater instruments is comparatively loaded down with trivial details, and this can cause operating time longer, the misery increasing operation risk and bring to surgical patient.
And occurred endoscope-assistant surgery the 1980s, it main to make surgeon when performing a surgical operation without the need to causing patient when huge wound for a kind of through endoscope and various imaging technique.For open surgery, endoscope-assistant surgery has the significant advantages such as little to disorganization, post-operative recovery is fast, thus becomes the trend of development.In this case, having occurred the purse-string forceps for endoscope-assistant surgery, there is the single problem of above-mentioned functions in the existing purse-string forceps for endoscope-assistant surgery equally.
Summary of the invention
The object of this invention is to provide a kind of end effector and a kind of surgical operating instrument, purse string suture, cutting and stitching can be completed, to simplify, operating operating process is carried out to lumen organization, reduce the misery of operating time, operation risk and patient, can also endoscope-assistant surgery be used for further.
The end effector that the embodiment of the present invention provides, comprising:
First tong arm and the second tong arm, described first tong arm and described second tong arm can under the effect of opening and closing mechanism relative motion, to open with the jaw making described first tong arm and described second tong arm be formed or closed;
Suturing mechanism, described suturing mechanism is arranged on the side of the longitudinal direction of described first tong arm and described second tong arm;
Purse string suture mechanism, described purse string suture organization establishes is at the opposite side of the longitudinal direction of described first tong arm and described second tong arm;
Cutting mechanism, described cutting mechanism is arranged between described suturing mechanism and described purse string suture mechanism;
Described purse string suture mechanism comprises:
At least one first clip tooth that described first tong arm is arranged, at least one second clip tooth that the position that described second tong arm is corresponding with described first clip tooth when jaw closes is arranged, described first clip tooth is vertically arranged with first along described first tong arm and threads a needle mouth, and described second clip tooth is vertically arranged with second along described second tong arm and threads a needle mouth;
First pocket pin, described first pocket pin is connected with purse wire one end, and described first pocket pin can move along the described first mouth of threading a needle under the effect of pocket needle drive mechanism;
Second pocket pin, described second pocket pin is connected with the purse wire other end, and described second pocket pin can move along the described second mouth of threading a needle under the effect of pocket needle drive mechanism.
Further, described suturing mechanism comprises:
The nail anvil that described first tong arm is arranged, the nail kit that the position that described second tong arm is corresponding with described nail anvil when jaw closes is arranged, is provided with staple in described nail kit, and described staple can be pulled the trigger by ejector pin mechanism.
Further, described ejector pin mechanism comprises: ejector pin bar, ejector pin slide block and nail pushing device, when described ejector pin bar is distad described in zigzag tread patterns during ejector pin slide block, the inclined-plane of described ejector pin slide block laterally drives described nail pushing device, makes described nail pushing device that described staple is released described nail kit and at the effect compacted under of described nail anvil.
Further, described cutting mechanism comprises: the cutter that can move between described suturing mechanism and described purse string suture mechanism under the effect of push broach mechanism.
Preferably, described first tong arm and described second tong arm have the cutter groove holding the motion of described cutter.
Optionally, described first tong arm and described second tong arm are rotating movable tong arm; Or described first tong arm is non-rotatable fixing tong arm, described second tong arm is rotating movable tong arm; Or described second tong arm is non-rotatable fixing tong arm, described first tong arm is rotating movable tong arm.
Preferably, described opening and closing mechanism comprises closed bar, described closed bar distal end portion is provided with closure flange, stage clip is provided with between described first tong arm and described second tong arm, when described closed bar is by driving during longitudinal distal motion, described closure flange engages the closing face on the first tong arm and/or the second tong arm and makes described jaw overcome the elastic force of described stage clip and close, and when described closed bar rollback, described jaw can open under the reset response of described stage clip.
Optionally, in described opening and closing mechanism, described suturing mechanism, described purse string suture mechanism and described cutting mechanism, at least both are synchronously driven; Or,
Described opening and closing mechanism, described suturing mechanism, described purse string suture mechanism and described cutting mechanism are driven separately.
Preferably, at least one first clip tooth described and at least one second clip tooth described are side set arrangement.
Preferably, described first pocket pin and described second pocket pin comprise respectively: shank and syringe needle, described syringe needle is connected with described shank is dismantled and assembled, and described purse wire is connected to described syringe needle.
More excellent, the distal end of described first tong arm or the second tong arm has mouth and described second of threading a needle with described first respectively when jaw closes and to thread a needle relative two the syringe needle fixing holes in mouthful position, and each described syringe needle is solidly plugged in corresponding described syringe needle fixing hole after stretching out corresponding mouth of threading a needle.
Preferably, described syringe needle and described syringe needle fixing hole are interference fit; Or described syringe needle fixing hole inwall has the projection stoping described syringe needle rollback.
Preferably, the afterbody of described syringe needle has jack, and the head of described shank is conical nose, and described conical nose is inserted in described jack.
Optionally, described end effector is the end effector with chamber mirror specification.
The surgical operating instrument that the embodiment of the present invention provides, comprising: handle and the end effector as described in aforementioned arbitrary technical scheme by described handle drives.
Preferably, this surgical operating instrument also comprises the slender bodies that inside is provided with drive mechanism, the distally of described handle is connected with described end effector by described slender bodies, and the opening and closing that described handle is described end effector by described drive mechanism, stitching, cutting and purse string suture provide driving.
In this technical scheme, the suturing mechanism of end effector side can realize the stitching of tissue, the purse string suture mechanism of opposite side can realize the purse string suture of tissue, cutting mechanism between suturing mechanism and purse string suture mechanism then can realize the cutting of tissue, visible, use end effector provided by the present invention can realize the purse string suture of tube chamber remaining end tissue, and the cutting of pathological changes end tissue and stitching, compared with prior art, enormously simplify and operating operating process is carried out to lumen organization, decrease operating time, alleviate the wound brought to surgical patient.
The purse-string forceps that the embodiment of the present invention provides, comprising:
First tong arm and the second tong arm, described first tong arm and described second tong arm can under the effect of opening and closing mechanism relative motion, to open with the jaw making described first tong arm and described second tong arm be formed or closed;
Purse string suture mechanism, comprise: at least one first clip tooth that described first tong arm is arranged, at least one second clip tooth that the position that described second tong arm is corresponding with described first clip tooth when jaw closes is arranged, described first clip tooth is vertically arranged with first along described first tong arm and threads a needle mouth, and described second clip tooth is vertically arranged with second along described second tong arm and threads a needle mouth;
First pocket pin, described first pocket pin is connected with purse wire one end, and described first pocket pin can move along the described first mouth of threading a needle under the effect of pocket needle drive mechanism;
Second pocket pin, described second pocket pin is connected with the purse wire other end, and described second pocket pin can move along the described second mouth of threading a needle under the effect of pocket needle drive mechanism;
The distal end of described first tong arm or described second tong arm has mouth and described second of threading a needle with described first respectively when jaw closes and to thread a needle relative two the syringe needle fixing holes in mouthful position;
Described first pocket pin and described second pocket pin comprise respectively: shank and syringe needle, described syringe needle is connected with described shank is dismantled and assembled, described syringe needle is connected with purse wire, and each described syringe needle is solidly plugged in corresponding described syringe needle fixing hole after stretching out corresponding mouth of threading a needle.
Optionally, described opening and closing mechanism and described purse string suture mechanism are synchronously driven; Or described opening and closing mechanism and described purse string suture mechanism are driven separately.
Optionally, described syringe needle and described syringe needle fixing hole are interference fit; Or described syringe needle fixing hole inwall has the projection stoping described syringe needle rollback.
Preferably, the afterbody of described syringe needle has jack, and the head of described shank is conical nose, and described conical nose is inserted in described jack.
In the technical scheme of purse-string forceps of the present invention, pocket pin comprises removable syringe needle and shank, the distal head of the first tong arm or the second tong arm has two syringe needle fixing holes, after pocket pin stretches out mouth of threading a needle accordingly, the syringe needle of pocket pin is just solidly plugged in corresponding syringe needle fixing hole, along with the reset of shank, syringe needle is separated with shank, and final syringe needle is stayed in syringe needle fixing hole.The program not only can avoid needle point to expose purse-string forceps, and syringe needle can be avoided to fall in human body, substantially increases the safety of operation.
Accompanying drawing explanation
Fig. 1 a is the schematic cross-section of lumen organization's purse string suture;
Fig. 1 b is the front view of lumen organization after purse wire tightens up;
Fig. 2 a is existing a kind of purse-string forceps purse string suture principle schematic;
Fig. 2 b is existing another kind of purse-string forceps purse string suture principle schematic;
Fig. 3 is the end effector perspective view of the embodiment of the present invention;
Fig. 4 a is the internal structure schematic cross-section (purse string suture side, jaw is in closure state) of the end effector of the embodiment of the present invention;
Fig. 4 b is the A place close-up schematic view of Fig. 4 a;
Fig. 4 c is the internal structure schematic three dimensional views (purse string suture side, jaw is in closure state) of the end effector of the embodiment of the present invention;
Fig. 5 a is the internal structure schematic cross-section (tissue apposition side, jaw is in closure state) of the end effector of the embodiment of the present invention;
Fig. 5 b is the internal structure schematic three dimensional views (tissue apposition side, jaw is in closure state) of the end effector of the embodiment of the present invention;
Fig. 5 c is the internal structure schematic three dimensional views (in the course of action of purse string suture, tissue apposition and cutting) of the end effector of the embodiment of the present invention;
Fig. 6 a is the internal structure side view (tissue apposition side, jaw is in open mode) of the end effector of the embodiment of the present invention;
Fig. 6 b is the fixed form schematic diagram of pocket pin in the end effector of the embodiment of the present invention;
Fig. 7 a is syringe needle and the shank structural representation of pocket pin in the embodiment of the present invention;
Fig. 7 b is syringe needle and the purse wire fixed form schematic diagram of pocket pin in the embodiment of the present invention;
Fig. 7 c is that the syringe needle of pocket pin in the embodiment of the present invention is fixed on syringe needle fixing hole schematic diagram;
Fig. 7 d is that the shank of pocket pin in the embodiment of the present invention resets, schematic diagram when jaw is opened;
Fig. 8 is the surgical operating instrument structural representation of the embodiment of the present invention.
Critical piece Reference numeral of the present invention:
10a-first tong arm 10b-second tong arm 11a-first clip tooth
11b-second clip tooth 12-nail anvil 13a-first threads a needle mouth
13b-second threads a needle mouthful 14-nail kit 15-cutter
16a-first pocket pin 16b-second pocket pin 17-purse wire
18-staple 19-cutter groove 20-pushing block
21-insertion tube 22-nail pushing device 23-ejector pin slide block
24-inclined-plane 25-lumen organization 26-closure flange
27-handle 28-end effector 29-slender bodies
30-shank 31-syringe needle 32-jack
33-syringe needle fixing hole 34-pressuring line groove 35-briquetting
36-groove 37-drive mechanism
Detailed description of the invention
Just purse string suture, cutting and stitching can be completed in order to use same apparatus, simplify needing the tissue (particularly lumen organization) carrying out purse string suture to carry out operating operating process, reduce the misery of operating time, risk and patient, can be used in endoscope-assistant surgery further, embodiments provide a kind of end effector and a kind of surgical operating instrument.In technical solution of the present invention, the suturing mechanism of end effector side can realize the stitching of tissue, the purse string suture mechanism of opposite side can realize the purse string suture of tissue, cutting mechanism between suturing mechanism and purse string suture mechanism then can realize the cutting of tissue, the end effector using the embodiment of the present invention to provide or surgical operating instrument can realize the purse string suture of tube chamber remaining end tissue, and the cutting of pathological changes end tissue and stitching, enormously simplify and operating operating process is carried out to lumen organization, decrease operating time, also can be used for endoscope-assistant surgery further.For making the object, technical solutions and advantages of the present invention clearly, by the following examples the present invention is described in further detail.
Shown in composition graphs 3, Fig. 4 a ~ Fig. 4 c, the end effector of the embodiment of the present invention, comprising:
First tong arm 10a and the second tong arm 10b, the first tong arm 10a and the second tong arm 10b can under the effect of opening and closing mechanism relative motion, to open with the jaw making the first tong arm 10a and the second tong arm 10b be formed or closed;
Suturing mechanism, suturing mechanism is arranged on the side of the longitudinal direction of the first tong arm 10a and the second tong arm 10b;
Purse string suture mechanism, purse string suture organization establishes is at the opposite side of the longitudinal direction of the first tong arm 10a and the second tong arm 10b;
Cutting mechanism, cutting mechanism is arranged between suturing mechanism and purse string suture mechanism;
Purse string suture mechanism comprises:
At least one first clip tooth 11a that first tong arm 10a is arranged, at least one second clip tooth 11b that the position that second tong arm 10b is corresponding with the first clip tooth 11a when jaw closes is arranged, first clip tooth 11a is vertically arranged with the first thread a needle a mouthful 13a, the second clip tooth 11b along the first tong arm 10a and is vertically arranged with second along the second tong arm 10b and threads a needle a mouthful 13b;
First pocket pin 16a, the first pocket pin 16a is connected with purse wire 17 one end, and the first pocket pin 16a can move along the first mouthful 13a that threads a needle under the effect of pocket needle drive mechanism;
Second pocket pin 16b, the second pocket pin 16b is connected with purse wire 17 other end, and the second pocket pin 16b can move along the second mouthful 13b that threads a needle under the effect of pocket needle drive mechanism.
In various embodiments of the present invention, away from the side of user when " distally " refers to that this apparatus is operated, near the side of user when " nearside " then refers to that this apparatus is operated." advance " is pointed to and is moved away from the direction of user, and " retrogressing " is then pointed to and moved near the direction of user.The end effector that the embodiment of the present invention provides can coordinate driving mechanism to use, and provides driving force by driving mechanism.The specific constructive form of driving mechanism is not limit, such as, directly the end effector of existing stapler front end can be unloaded, the end effector embodiment of the present invention provided is loaded onto, by the driving mechanism of existing stapler be opening and closing mechanism, suturing mechanism, purse string suture mechanism and cutting mechanism provide driving force.In addition, the other design driven mechanism of the end effector that also can provide for the embodiment of the present invention.
The end effector that the embodiment of the present invention provides can be divided into opening and closing mechanism, suturing mechanism, purse string suture mechanism and cutting mechanism four part according to function.Wherein, the opening and closing of the jaw that opening and closing mechanism is formed for two tong arms realizing end effector, jaw can be driven during use to open lumen organization to be performed the operation to be placed in one, then jaw is driven to close lumen organization's clamping to carry out the surgical action such as purse string suture, cutting, stitching, and after surgical action terminates, jaw can be driven again to open to discharge tissue.Cutting mechanism, can by the pathological changes end of lumen organization and remaining end cutting and separating for realizing the cutting function to tissue.Suturing mechanism, can be sewed up in the incision of lumen organization's pathological changes end the stitching function of tissue for realizing.Purse string suture mechanism to the purse string suture function of tissue, can carry out purse string suture in the incision of lumen organization's remaining end for realizing, and to coordinate the nail anvil installing round anastomat in subsequent operation, uses round anastomat to carry out coincideing grade for operation.This tetrameric structure will be further described respectively below.
In the end effector of the embodiment of the present invention, can at least both synchronously be driven in opening and closing mechanism, suturing mechanism, purse string suture mechanism and cutting mechanism; Also can be that opening and closing mechanism, suturing mechanism, purse string suture mechanism and cutting mechanism are driven separately.The concrete structure of end effector can be designed according to different type of drive.
Opening and closing mechanism:
In the various embodiments of the invention, the first tong arm 10a and the second tong arm 10b can be movable relatively, and can be rotating movable tong arm; Or the first tong arm 10a is non-rotatable fixing tong arm, the second tong arm 10b is rotating movable tong arm; Or the second tong arm 10b is non-rotatable fixing tong arm, the first tong arm 10a is rotating movable tong arm.Two tong arms no matter only have a movable tong arm or two are movable tong arm, as long as can be driven the jaw opening and closing that make two tong arms be formed.
The opening and closing mechanism of end effector of the present invention can adopt the various technical schemes of the opening and closing mechanism of the end effector of existing stapler to realize, such as, and bushing type opening and closing scheme, I-shaped beam type opening and closing scheme etc.
Such as, opening and closing mechanism can comprise closed bar, closed bar distal end portion is provided with closure flange, stage clip is provided with between first tong arm and the second tong arm, when closed bar is by driving during longitudinal distal motion, closure flange engages the closing face on the first tong arm 10a and/or the second tong arm 10b, makes tong arm overcome the elastic force of stage clip and close, when closed bar rollback, jaw can open under the reset response of stage clip.When closed bar is by driving during longitudinal distal motion, closure flange only can engage the closing face on the first tong arm 10a or the second tong arm 10b, but in order to obtain comparatively balance stressed, preferably, closure flange engages the closing face on the first tong arm 10a and the second tong arm 10b simultaneously.
Wherein, closed bar can from the ejector pin bar for pulling the trigger staple, for driving the knife bar of cutter or for driving the pocket pin drive rod of pocket pin be structure as a whole or be interconnected for different parts; Closed bar, ejector pin bar, knife bar or pocket pin drive rod also can be different parts respectively; Closed bar also can from ejector pin bar, knife bar and pocket pin drive rod arbitrarily both are structure as a whole or are interconnected for different parts; In addition, also can be that closed bar is structure as a whole (can be described as drive rod) from ejector pin bar, knife bar and pocket pin drive rod or is interconnected for different parts.
Shown in Fig. 5 b and Fig. 6 a, in one particular embodiment of the present invention, cutter 15 and knife bar are integrative-structure and as the closed bar of opening and closing mechanism, be provided with stage clip (not shown) between first tong arm 10a and the second tong arm 10b, the side that the distal end portion of closed bar deviates from jaw at movable tong arm is fixed with the closure flange 26 being parallel to cut direction; When closed bar advances, closure flange 26 promotion activity tong arm turns to jaw and closes, and when closed bar retreats, stage clip promotion activity tong arm turns to jaw and opens.Here it should be noted that, the stroke that closure flange 26 is walked when closing jaw does not need very large.
Cutting mechanism:
The cutting mechanism of end effector of the present invention can adopt the various technical schemes of the cutting mechanism of the end effector of existing stapler to realize.
Such as, as shown in Figure 3, cutting mechanism can comprise cutter 15, cutter 15 can move under the effect of push broach mechanism between suturing mechanism and purse string suture mechanism, with by carry out respectively sewing up with purse string suture organize cutting and separating, push broach mechanism can be push broach bar or miscellaneous part, cutter 15 and push broach mechanism can be one also can be split (now, cutter 15 are arranged on the distally of push broach mechanism).First tong arm 10a and the second tong arm 10b can be provided with the cutter groove 19(of accommodation cutter 15 motion due to viewing angles reason, and the cutter groove of the second tong arm 10b is not shown), think that the motion of cutter 15 provides guiding, make cutting movement more steadily, accurately.
Suturing mechanism:
The suturing mechanism of end effector of the present invention can adopt the various technical schemes of the suturing mechanism of the end effector of existing stapler to realize.
Such as, as shown in Fig. 5 a ~ Fig. 5 c, suturing mechanism can be arranged on the side of the longitudinal direction of two tong arms, a tong arm arranges nail anvil, and another tong arm arranges nail kit and (in the embodiment shown in Fig. 5 a ~ Fig. 5 c, is specially on the first tong arm 10a and arranges nail anvil 12, the position that second tong arm 10b is corresponding with nail anvil 12 when jaw closes arranges nail kit 14), arrange staple 18 in nail kit 14, staple 18 can be set to a row or multi-row along the longitudinal direction, and staple 18 can be pulled the trigger by ejector pin mechanism.Ejector pin mechanism for pulling the trigger staple 18 can comprise ejector pin bar (in this embodiment, the knife bar of cutter 15 is as ejector pin bar), ejector pin slide block 23 and nail pushing device 22.As shown in Figure 5 a to 5 c, percussion process can be the distad lengthwise movement and drive ejector pin slide block 23 of ejector pin bar, the inclined-plane 24 of ejector pin slide block 23 acts on nail pushing device 22 and makes its transverse movement, then staple 18 released nail kit 14, through organizing and compressing nail anvil 12 by nail pushing device 22, staple 18 is B shape at the effect compacted under of nail anvil 12, thus completes stitching.
The row of staple 18 is not limit, but at least should be a row, is preferably at least two rows (shown in Fig. 5 c), like this, can carry out at least twice and sew up, greatly reduce and sew up failed risk at the pathological changes end of lumen organization.When staple 18 is longitudinally set to arrange more, multiple nail pushing devices 22 that an ejector pin slide block 23 promotes front can be only set.
When the knife bar of cutter 15 is as ejector pin bar, the position of cutter 15 can be set to relative to ejector pin slide block 23 more rearward (namely more near nearside), make first to sew up rear cutting, the outflow of pathological changes end interior tissue can be reduced like this, improve the success rate of operation.In one embodiment, the knife bar that ejector pin slide block 23 is cut cutter 15 promotes, before the blade of cutter 15 cuts tissue, staple 18 is pulled the trigger by the nail pushing device 22 that the inclined-plane 24 of ejector pin slide block 23 has promoted front, namely first by the tissue apposition in front, therefore, cutter 15 always just cut after tissue apposition.
Purse string suture mechanism:
Purse string suture mechanism can be arranged on the opposite side of the longitudinal direction of two tong arms, namely relative with suturing mechanism side.Purse string suture mechanism can comprise two groups of clip tooths of corresponding setting on two tong arms, often organizes clip tooth and can comprise at least one clip tooth, and often organize in clip tooth and be vertically arranged with along tong arm mouth of threading a needle, mouth of threading a needle can be hole or breach.
Purse string suture mechanism also comprises two pocket pins, two pocket pins are connected with one end of a purse wire respectively, pocket pin can move along mouth of threading a needle under the effect of pocket needle drive mechanism, to pass tissue with purse wire, thus realizing purse string suture, pocket needle drive mechanism can be pocket pin drive rod or miscellaneous part.
As shown in Fig. 4 a to Fig. 4 c, in one embodiment, when jaw closes, at least one first clip tooth 11a is relative with at least one second clip tooth 11b position and clamp therebetween by lumen organization 25, subsequently with two pocket pins (i.e. first pocket pin 16a and the second pocket pin 16b of purse wire 17, purse wire 17 is fixed on the head of pocket pin by tying-up mode) under the driving of pocket pin drive rod respectively along two mouths of threading a needle (namely first thread a needle mouthful 13a and second to thread a needle a mouthful 13b) distal motion, thus through by the lumen organization 25 that clamps so that purse wire 17 is attached to lumen organization 25.The arrangement mode of the first clip tooth 11a and the second clip tooth 11b is not limit.Such as, Ke Yiwei, two groups of clip tooths tooth tooth arranged opposite when jaw closes, uses the clip tooth of this structure when carrying out purse string suture, and purse wire through the top layer of lumen organization, can only exist the risk come off usually.Preferably, as shown in Figure 4 b, at least one first clip tooth 11a and at least one second clip tooth 11b is side set arrangement, like this, when carrying out purse string suture, lumen organization 25 clamps by least one first clip tooth 11a and at least one the second clip tooth 11b of the arrangement in side set, and purse wire 17 can pass organization internal layer, difficult drop-off, the success rate of purse string suture is higher.The concrete shape of mouth of threading a needle is not limit, and for ease of production and processing, in this programme, mouth of threading a needle is the breach in jaw side with opening, also can be the hole of closing structure.
Closed bar, ejector pin bar, knife bar and pocket pin drive rod can be structure as a whole or different parts are mutually permanently connected, and can realize synchronous driving like this.As shown in Figure 6 a, cutter 15 and knife bar are structure as a whole, and the knife bar of cutter 15 is simultaneously as closed bar, ejector pin bar and pocket pin drive rod.In the embodiment shown in Fig. 6 b, for ease of production and processing and installation, the proximal end of the knife bar of cutter 15 is fixed with pushing block 20, and pushing block 20 has two insertion tubes 21, first pocket pin 16a and the second pocket pin 16b is individually fixed in two insertion tubes 21.
As shown in Figure 7a, the first pocket pin 16a and the second pocket pin 16b comprises shank 30 and syringe needle 31 respectively, and syringe needle 31 is connected removably with shank 30, and purse wire (this is not shown) is connected to syringe needle 31.Syringe needle 31 is not limit with the dismantled and assembled connected mode of shank 30, and preferably, the afterbody of syringe needle 31 has jack 32, and the head of shank 30 is conical nose, and conical nose is inserted in jack 32.Adopt the connected mode of plug-in, the assembling being more convenient to syringe needle 31 and shank 30 be separated.After syringe needle 31 passes from mouth of threading a needle, can be separated by syringe needle 31 easily with shank 30, be cut off the junction of purse wire and syringe needle 31, take out tight purse wire and can complete purse string suture, operating procedure is comparatively easy.
The fixed form of purse wire and syringe needle is not limit, and such as, can arrange through wires hole on syringe needle, and purse wire penetrates through wires hole and tying-up is fixed, and the mode shown in Fig. 4 b also can be adopted purse wire and the direct tying-up of syringe needle to be fixed.Preferably, as shown in Figure 7b, syringe needle 31 has a pressuring line groove 34, one end of purse wire 17 to be placed in pressuring line groove 34 and to be compressed by a briquetting 35, briquetting 35 and pressuring line groove 34 are interference fit, thus realize the connection of purse wire 17 and syringe needle 31, and briquetting 35 can adopt has elastic plastic cement material, be convenient to like this in press-in pressuring line groove 34, and the elasticity of briquetting 35 can be fixed on firm for purse wire 17 in pressuring line groove 34.Adopt the connection of this structure purse wire 17 comparatively firm, and operation is comparatively convenient.
As shown in Figure 7 c, tong arm (both can be the first tong arm 10a, also can be the second tong arm 10b) distal end there are two relative syringe needle fixing holes 33 of mouthful position of threading a needle with two respectively when jaw closes, each syringe needle 31 is solidly plugged in corresponding syringe needle fixing hole 33 after stretching out corresponding mouth of threading a needle.
In the technical scheme of this embodiment, after pocket pin stretches out mouth of threading a needle, the syringe needle 31 of pocket pin is just solidly plugged in corresponding syringe needle fixing hole 33, and along with the rollback of shank 30 resets, syringe needle 31 is separated with shank 30, and final syringe needle 31 is stayed in syringe needle fixing hole 33.The program not only can avoid needle point to expose apparatus, and syringe needle can be avoided to fall in human body, substantially increases the safety of operation.
Syringe needle 31 is not limit with the fixed structure form of syringe needle fixing hole 33, and such as, in one embodiment, syringe needle 31 and syringe needle fixing hole 33 are interference fit, realizes syringe needle 31 fixing in syringe needle fixing hole 33 by interference fit; In another embodiment, syringe needle fixing hole 33 inwall has the projection stoping syringe needle 31 rollback, and these schemes all can prevent the rollback of syringe needle 31.
As shown in figure 7d, after syringe needle 31 inserts syringe needle fixing hole 33 and be fixed, shank 30 resets with pocket pin drive rod, be separated with syringe needle 31, after jaw opens, from the junction of purse wire 17 and two syringe needles 31, purse wire 17 is cut off, take out tight purse wire 17 and can complete purse string suture.Because end effector is generally disposable apparatus, after purse string suture terminates, the inside of disposable end effector stayed by syringe needle 31, thus avoid falling in body.
In the technical scheme of the embodiment of the present invention, closed bar, ejector pin bar, knife bar and pocket pin drive rod can be structure as a whole or be interconnected to realize synchronous driving for different parts, such as, in one embodiment, closed bar, ejector pin bar, knife bar and pocket pin drive rod are structure as a whole, and can be described as drive rod.During use, drive rod distal motion is to drive, first drive opening and closing mechanism with closed tong arm, along with the further motion of drive rod, suturing mechanism and purse string suture mechanism are driven, staple is pulled the trigger to realize to sew up successively, pocket pin passes tissue to realize purse string suture with purse wire along mouth of threading a needle, cutter cut tissue under the promotion of drive rod between suturing mechanism and purse string suture mechanism simultaneously, thus complete cutting simultaneously, sew up and purse string suture, this further simplify and carries out operating operating process to lumen organization, decrease operating time, thus further mitigate the wound brought to surgical patient.
To sum up, in technical solution of the present invention, the suturing mechanism of end effector side can realize the stitching of tissue, the purse string suture mechanism of opposite side can realize the purse string suture of tissue, cutting mechanism between suturing mechanism and purse string suture mechanism then can realize the cutting of tissue, visible, the end effector using the embodiment of the present invention to provide can realize the purse string suture of tube chamber remaining end tissue, and the cutting of pathological changes end tissue and stitching, compared with prior art, greatly reduce the frequency changing operating theater instruments, simplify and operating operating process is carried out to lumen organization, decrease operating time, alleviate the wound brought to surgical patient.
It should be noted that, in various embodiments of the present invention, the specification of end effector is not limit, and can design according to concrete operation needs.Such as, when end effector is the end effector with chamber mirror specification, can use by mating cavity mirror, operation is had concurrently, and safety is high, wound surface is little, pain is few, recover the advantage such as fast.
As shown in Figure 8, the embodiment of the present invention additionally provides a kind of surgical operating instrument, comprising: handle 27 and the end effector 28 as aforementioned any embodiment driven by handle 27.
The slender bodies 29 that inside is provided with drive mechanism 37 is also comprised in this embodiment, the distally of handle 27 is connected with end effector 28 by slender bodies 29, handle 27 drive transmission device 37, drive mechanism 37 and then driving is passed to end effector 28, thinks that its opening and closing, stitching, cutting and purse string suture provide driving.The surgical operating instrument with this structure can use by mating cavity mirror, and operation is had concurrently, and safety is high, wound surface is little, pain is few, recover the advantage such as fast.
The surgical operating instrument using the embodiment of the present invention to provide can realize the purse string suture of tube chamber remaining end tissue, and the cutting of pathological changes end tissue and stitching, compared with prior art, enormously simplify and operating operating process is carried out to lumen organization, decrease operating time, alleviate the wound brought to surgical patient, can also endoscope-assistant surgery be used for further.
Can refer to shown in Fig. 7 c and Fig. 7 d, the embodiment of the present invention additionally provides a kind of purse-string forceps, comprising:
First tong arm 10a and the second tong arm 10b, the first tong arm 10a and the second tong arm 10b can under the effect of opening and closing mechanism relative motion, to open with the jaw making the first tong arm 10a and the second tong arm 10b be formed or closed;
Purse string suture mechanism, comprise: at least one first clip tooth 11a that the first tong arm 10a is arranged, at least one second clip tooth 11b that the position that second tong arm 10b is corresponding with the first clip tooth 11a when jaw closes is arranged, first clip tooth 11a is vertically arranged with the first thread a needle a mouthful 13a, the second clip tooth 11b along the first tong arm 10a and is vertically arranged with second along the second tong arm 10b and threads a needle a mouthful 13b;
First pocket pin, the first pocket pin is connected with purse wire 17 one end, and the first pocket pin can move along the first mouthful 13a that threads a needle under the effect of pocket needle drive mechanism;
Second pocket pin, the second pocket pin is connected with purse wire 17 other end, and the second pocket pin can move along the second mouthful 13b that threads a needle under the effect of pocket needle drive mechanism;
The distal end portion of the first tong arm 10a or the second tong arm 10b has mouthful 13a and second that to thread a needle with first respectively when jaw closes and to thread a needle relative two the syringe needle fixing holes 33 in mouthful 13b position;
First pocket pin and the second pocket pin comprise respectively: shank 30 and syringe needle 31, and syringe needle 31 is connected with shank 30 is dismantled and assembled, and syringe needle 31 is connected with purse wire 17, and each syringe needle 31 is solidly plugged in corresponding syringe needle fixing hole 33 after stretching out corresponding mouth of threading a needle.
The purse-string forceps that the embodiment of the present invention provides, the concrete form of tong arm opening and closing mechanism is not limit, such as, the version similar with aforementioned end effector can be adopted, also the version that general surgery clamps can be adopted, first tong arm and the second tong arm hinged, by operator's manual operation two levers, jaw is closed.When adopting the version similar with aforementioned end effector, opening and closing mechanism and purse string suture mechanism can synchronously be driven, at this moment closed bar and pocket pin drive rod can be structure as a whole or different parts are interconnected to realize synchronous driving, in addition, opening and closing mechanism and purse string suture mechanism also can be driven separately.
Syringe needle 31 is not limit with the dismantled and assembled connected mode of shank 30, preferably, can with reference to shown in figure 7a, the afterbody of syringe needle 31 has jack 32, and the head of shank 30 is conical nose, and conical nose is inserted in jack 32.Adopt the connected mode of plug-in, the assembling being more convenient to syringe needle 31 and shank 30 be separated.
The connected mode of purse wire and syringe needle is not limit, and such as, can arrange through wires hole on syringe needle, and purse wire penetrates through wires hole and tying-up is fixed, and the mode shown in Fig. 4 b also can be adopted purse wire and the direct tying-up of syringe needle to be fixed.Preferably, can refer to shown in Fig. 7 b, syringe needle 31 has a pressuring line groove 34, one end of purse wire 17 to be placed in pressuring line groove 34 and to be compressed by a briquetting 35, briquetting 35 and pressuring line groove 34 are interference fit, thus realize purse wire 17 and the connection of syringe needle 31, adopt the connection of this structure purse wire 17 comparatively firm, and operation is comparatively convenient.
In the technical scheme of this embodiment, after pocket pin stretches out mouth of threading a needle, the syringe needle 31 of pocket pin is just solidly plugged in corresponding syringe needle fixing hole 33, and along with the reset of shank 30, syringe needle 31 is separated with shank 30, and final syringe needle 31 is stayed in syringe needle fixing hole 33.The program not only can avoid needle point to expose apparatus, and syringe needle can be avoided to fall in human body, substantially increases the safety of operation.
Syringe needle 31 is not limit with the fixed structure form of syringe needle fixing hole 33, and such as, in one embodiment, syringe needle 31 and syringe needle fixing hole 33 are interference fit, realizes syringe needle 31 fixing in syringe needle fixing hole 33 by interference fit; In another embodiment, syringe needle fixing hole 33 inwall has the projection stoping syringe needle 31 rollback, and these schemes all can prevent the rollback of syringe needle 31.After syringe needle 31 inserts syringe needle fixing hole 33 and is fixed, shank 30 resets with pocket pin drive rod, is separated, with syringe needle 31 after jaw opens, from the junction of purse wire 17 and two syringe needles 31, purse wire 17 is cut off, take out tight purse wire 17 and can complete purse string suture.Because end effector is generally disposable apparatus, after purse string suture terminates, the inside of disposable end effector stayed by syringe needle 31, thus avoid falling in body.
Obviously, those skilled in the art can carry out various change and modification to the present invention and not depart from the spirit and scope of the present invention.Like this, if these amendments of the present invention and modification belong within the scope of the claims in the present invention and equivalent technologies thereof, then the present invention is also intended to comprise these change and modification.

Claims (21)

1. an end effector, is characterized in that, comprising:
First tong arm (10a) and the second tong arm (10b), described first tong arm (10a) and described second tong arm (10b) can under the effect of opening and closing mechanism relative motion, to open with the jaw making described first tong arm (10a) and described second tong arm (10b) be formed or closed;
Suturing mechanism, described suturing mechanism is arranged on the side of the longitudinal direction of described first tong arm (10a) and described second tong arm (10b);
Purse string suture mechanism, described purse string suture organization establishes is at the opposite side of the longitudinal direction of described first tong arm (10a) and described second tong arm (10b);
Cutting mechanism, described cutting mechanism is arranged between described suturing mechanism and described purse string suture mechanism;
Described purse string suture mechanism comprises:
Upper at least one first clip tooth (11a) arranged of described first tong arm (10a), at least one second clip tooth (11b) that described second tong arm (10b) position corresponding with described first clip tooth (11a) when jaw closes is arranged, described first clip tooth (11a) is vertically arranged with first along described first tong arm (10a) and threads a needle mouth (13a), and described second clip tooth (11b) is vertically arranged with second along described second tong arm (10b) and threads a needle mouth (13b);
First pocket pin (16a), described first pocket pin (16a) is connected with purse wire (17) one end, described first pocket pin (16a) can under the effect of pocket needle drive mechanism along described first thread a needle mouth (13a) motion;
Second pocket pin (16b), described second pocket pin (16b) is connected with purse wire (17) other end, described second pocket pin (16b) can under the effect of pocket needle drive mechanism along described second thread a needle mouth (13b) motion.
2. end effector as claimed in claim 1, it is characterized in that, described suturing mechanism comprises:
The upper nail anvil (12) arranged of described first tong arm (10a), the nail kit (14) that described second tong arm (10b) position corresponding with described nail anvil (12) when jaw closes is arranged, be provided with staple (18) in described nail kit (14), described staple (18) can be pulled the trigger by ejector pin mechanism.
3. end effector as claimed in claim 2, it is characterized in that, described ejector pin mechanism comprises: ejector pin bar, ejector pin slide block (23) and nail pushing device (22), when described ejector pin bar is distad described in zigzag tread patterns time ejector pin slide block (23), the inclined-plane (24) of described ejector pin slide block (23) laterally drives described nail pushing device (22), makes described nail pushing device (22) that described staple (18) is released described nail kit (14) and at the effect compacted under of described nail anvil (12).
4. end effector as claimed in claim 1, it is characterized in that, described cutting mechanism comprises: the cutter (15) that can move between described suturing mechanism and described purse string suture mechanism under the effect of push broach mechanism.
5. end effector as claimed in claim 4, is characterized in that, described first tong arm (10a) and described second tong arm (10b) have the cutter groove (19) holding described cutter (15) and move.
6. end effector as claimed in claim 1, it is characterized in that, described first tong arm (10a) and described second tong arm (10b) are rotating movable tong arm; Or described first tong arm (10a) is non-rotatable fixing tong arm, described second tong arm (10b) is rotating movable tong arm; Or described second tong arm (10b) is non-rotatable fixing tong arm, described first tong arm (10a) is rotating movable tong arm.
7. end effector as claimed in claim 6, it is characterized in that, described opening and closing mechanism comprises closed bar, described closed bar distal end portion is provided with closure flange (26), stage clip is provided with between described first tong arm (10a) and described second tong arm (10b), when described closed bar is by driving during longitudinal distal motion, described closure flange (26) engages the closing face on the first tong arm (10a) and/or the second tong arm (10b) and makes described jaw overcome the elastic force of described stage clip and close, when described closed bar rollback, described jaw can open under the reset response of described stage clip.
8. the end effector as described in any one of claim 1 ~ 7, is characterized in that,
In described opening and closing mechanism, described suturing mechanism, described purse string suture mechanism and described cutting mechanism, at least both are synchronously driven; Or,
Described opening and closing mechanism, described suturing mechanism, described purse string suture mechanism and described cutting mechanism are driven separately.
9. end effector as claimed in claim 1, it is characterized in that, at least one first clip tooth (11a) described and at least one second clip tooth (11b) described arrange in side set.
10. end effector as claimed in claim 1, it is characterized in that, described first pocket pin (16a) and described second pocket pin (16b) comprise respectively: shank (30) and syringe needle (31), described syringe needle (31) is connected with described shank (30) is dismantled and assembled, and described purse wire (17) is connected to described syringe needle (31).
11. end effectors as claimed in claim 10, it is characterized in that, the distal end of described first tong arm (10a) or the second tong arm (10b) has mouth (13a) and described second of threading a needle with described first respectively when jaw closes and to thread a needle relative two the syringe needle fixing holes (33) in mouth (13b) position, and each described syringe needle (31) is solidly plugged in corresponding described syringe needle fixing hole (33) after stretching out corresponding mouth of threading a needle.
12. end effectors as claimed in claim 11, is characterized in that, described syringe needle (31) and described syringe needle fixing hole (33) are interference fit; Or described syringe needle fixing hole (33) inwall has the projection stoping described syringe needle (31) rollback.
13. end effectors as claimed in claim 10, it is characterized in that, the afterbody of described syringe needle (31) has jack (32), and the head of described shank (30) is conical nose, and described conical nose is inserted in described jack (32).
14. end effectors according to any one of claim 1 ~ 7,9 ~ 13, it is characterized in that, described end effector is the end effector with chamber mirror specification.
15. end effectors as claimed in claim 8, it is characterized in that, described end effector is the end effector with chamber mirror specification.
16. 1 kinds of surgical operating instruments, is characterized in that, comprising: handle (27) and the end effector (28) as described in any one of claim 1 ~ 15 driven by described handle (27).
17. surgical operating instruments as claimed in claim 16, it is characterized in that, also comprise the slender bodies (29) that inside is provided with drive mechanism (37), the distally of described handle (27) is connected with described end effector (28) by described slender bodies (29), and the opening and closing that described handle (27) is described end effector (28) by described drive mechanism (37), stitching, cutting and purse string suture provide driving.
18. 1 kinds of purse-string forceps, is characterized in that, comprising:
First tong arm (10a) and the second tong arm (10b), described first tong arm (10a) and described second tong arm (10b) can under the effect of opening and closing mechanism relative motion, to open with the jaw making described first tong arm (10a) and described second tong arm (10b) be formed or closed;
Purse string suture mechanism, comprise: upper at least one first clip tooth (11a) arranged of described first tong arm (10a), at least one second clip tooth (11b) that described second tong arm (10b) position corresponding with described first clip tooth (11a) when jaw closes is arranged, described first clip tooth (11a) is vertically arranged with first along described first tong arm (10a) and threads a needle mouth (13a), and described second clip tooth (11b) is vertically arranged with second along described second tong arm (10b) and threads a needle mouth (13b);
First pocket pin (16a), described first pocket pin (16a) is connected with purse wire (17) one end, described first pocket pin (16a) can under the effect of pocket needle drive mechanism along described first thread a needle mouth (13a) motion;
Second pocket pin (16b); described second pocket pin (16b) is connected with purse wire (17) other end, described second pocket pin (16b) can under the effect of pocket needle drive mechanism along described second thread a needle mouth (13b) motion;
The distal end of described first tong arm (10a) or described second tong arm (10b) has mouth (13a) and described second of threading a needle with described first respectively when jaw closes and to thread a needle relative two the syringe needle fixing holes (33) in mouth (13b) position;
Described first pocket pin (16a) and described second pocket pin (16b) comprise respectively: shank (30) and syringe needle (31), described syringe needle (31) is connected with described shank (30) is dismantled and assembled, described syringe needle (31) is connected with purse wire (17), and each described syringe needle (31) is solidly plugged in corresponding described syringe needle fixing hole (33) after stretching out corresponding mouth of threading a needle.
19. purse-string forceps as claimed in claim 18, is characterized in that,
Described opening and closing mechanism and described purse string suture mechanism are synchronously driven; Or described opening and closing mechanism and described purse string suture mechanism are driven separately.
20. purse-string forceps as claimed in claim 18, is characterized in that, described syringe needle (31) and described syringe needle fixing hole (33) are interference fit; Or described syringe needle fixing hole (33) inwall has the projection stoping described syringe needle (31) rollback.
21. purse-string forceps as described in any one of claim 18 ~ 20, it is characterized in that, the afterbody of described syringe needle (31) has jack (32), and the head of described shank (30) is conical nose, and described conical nose is inserted in described jack (32).
CN201310438123.9A 2013-09-23 2013-09-23 End effector, surgical operating instrument and purse-string forceps Active CN104434243B (en)

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WO2020082052A1 (en) * 2018-10-19 2020-04-23 Eric Haas Devices and methods for minimally invasive surgical procedures
US11779342B2 (en) 2020-02-19 2023-10-10 Covidien Lp Laparoscopic purse string suture device

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